Late presentation of chronic HBV and HCV patients seeking first time specialist care in Spain: a 2-year registry review

Abstract

Chronic viral hepatitis infection affects an estimated 325 million people globally. People who initiate treatment after significant disease progression face increased risk of severe liver complications and death. Data are scarce on the characteristics and risk factors of people who present late to care in Spain and globally. Data were collected from January 2018 to December 2019 to report late presentation (LP) to specialist care at 11 large university hospitals in Spain to assess related risk factors using a multivariable logistic regression model. 2290 (CHB = 505, CHC = 1785) patients were analysed, with 581 (25.2%) presenting late. Hepatitis C patients more frequently reported LP compared to hepatitis B patients (28.1% vs 15.0%; p < 0.001). Older age (p < 0.001), being male (p < 0.001), being Spanish-born (p < 0.001), and having an unknown origin of referral (p = 0.08) were associated with a higher likelihood of LP. Advanced liver disease was identified in 533 (23%) patients and late-stage liver disease in 124 (5.4%). LP, including with irreversible liver damage, to viral hepatitis specialist care is frequent in Spain, despite being a country with unrestricted treatment access. Initiatives to reduce LP should specifically target men, older individuals, foreign-born populations for CHB, and Spanish nationals for CHC.

Map 1

Percent of HCV LP patients by country of origin (A) and number of HCV LP patients (N = 510) from each corresponding country (B). HCV hepatitis C virus, LP late presentation. Map was created using Tableau version 2021.1.0 (www.tableau.com).

Map 2

Percent of HBV LP patients by country of origin (A) and number of HBV LP patients (N = 78) from each corresponding country (B). HBV hepatitis B virus, LP late presentation. Map was created using Tableau version 2021.1.0 (www.tableau.com).